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1
Jonge, Evert de. "Pathophysiology and management of coagulation disorders in critical care medicine." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/56631.
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Hammond, Janet Margaret Justine. "Nosocomial infections in intensive care." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26477.
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The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.
3
BARTZ, CLAUDIA CAROL. "NURSE-PATIENT COMMUNICATION DURING CRITICAL ILLNESS EVENTS." Diss., The University of Arizona, 1986. http://hdl.handle.net/10150/183833.
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The purpose of this study was to explore and describe nurse-patient communication during critical illness events. The theoretical structure of the study was drawn from communication, sociolinguistic, and nursing theory. Data were collected in a 374-bed private hospital in the Southwest. The sample consisted of six registered nurses and nine patients experiencing cardiac surgery. Nine observed and audiotaped nurse-patient interactions, and fourteen audiotaped partcipant interviews provided the data base for analysis. Content analysis was used to organize the data. Findings were presented in terms of language, paralanguage, and nonverbal expression, and in terms of content, process, and product of nurse-patient communication. Participants used biomedical-technical language and casual-everyday language during the interactions. Nurses talked about what patients would experience while patients talked about themselves as a way of establishing their credibility within the biomedical setting. Nurses viewed nurse-patient communication as variable depending on the patients' needs and responses. Patients viewed nurse-patient communication as straightforward, not requiring adjustment for the needs of the participants. Products of communication for patients involved increased knowledge, reassurance, and increased confidence. Products of communication for nurses involved relieving the patients' anxieties, considering the patients' remembering, and increasing the nursing staff's knowledge about the patient while helping the patient to know the goals of the nursing staff. The introduction and closure segments of the six nurse-patient interactions for preoperative preparation of the patient were analyzed. Nurses began the introductions by assuming that the patients needed relief from anxiety but the patients demonstrated politeness more than anxiety. Nurses used strategies of questioning, starting the physical assessment, topic persistence, and self-monitoring to control the closure segments. Patients used narratives and humor as control strategies. The study findings suggest conceptual areas relevant to nurse-patient communication which may ground theoretical model development for nurse-patient communication. Nurses in clinical settings can compare their patient communication experiences with the findings of the study in order to increase their understanding of expression, form, and function of nurse-patient communication.
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Henderson, Alan. "Some ethical problems in adult intensive care : a physician's approach to ethical problems at the bedside /." [St. Lucia, Qld. : s.n.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16635.pdf.
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Kruger, Jeanne-Marié. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit /." Link to online version, 2006. http://hdl.handle.net/10019/564.
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Fataar, Danielle. "Endotracheal tube verification in the mechanically ventilated patient in a critical care unit." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008057.
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Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.
7
Ryder-Lewis, Michelle. "Reliability study of the sedation-agitation scale in an intensive care unit : a thesis submitted in partial fulfilment to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Arts (Applied) Nursing /." ResearchArchive@Victoria e-Thesis, 2004. http://hdl.handle.net/10063/59.
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Befile, Nomawethu. "The relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14576.
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Organisational change in any organisation, including the healthcare industry, implies a change in organisational culture. The concept of organisational culture refers to those values and norms within an organisation that are prescribed by both the employer and the employees as to how to behave. However, organisational culture should not be viewed in isolation, as culture and leadership are intertwined. Transformational leadership within an organisational culture serves to achieve its goal, missions and aims by influencing, motivating and creating a mutual relationship between employees and employers, which brings about effective organisational change. The alignment of organisational culture and leadership with a hospital’s vision is important to ensure optimal healthcare delivery and organisational change outcomes. A positivistic research paradigm, with a quantitative, explorative, descriptive and contextual approach, was used to conduct the research study. The research study explored whether a supportive organisational culture, transformational leadership and organisational change outcomes were prevalent in public intensive care units. Secondly, the study aimed to investigate the relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units in the Nelson Mandela Bay. Data was collected by means of a structured and previously validated questionnaire with a Cronbach’s alpha of more than 0.80. The target population was registered nurses who work in the intensive care units in the public hospitals. The sample was composed of 56 registered nurses and 4 enrolled nurses who were selected from public hospital intensive care units in Nelson Mandela Bay. Descriptive statistics, linear regression analysis, correlation and a Chi-square test were used to describe the hypothesised relationship between organisational culture and transformational leadership (independent) with organisational change outcomes (dependent variable). The results of this study revealed that the alternative hypothesis was accepted as the P value, was less than 0.05 in all variables. This proved that there was a significant relationship between organisational culture, transformational leadership and organisational change outcomes in the public intensive care units which were sampled. Recommendations are made as to how organisational culture can enhance and support transformational leadership and organisational change outcomes to promote a positive change outcome in public intensive care units. Ethical considerations were maintained throughout the research study.
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Cretikos, Michelle School of Anaesthetics Intensive Care & Emergency Medicine UNSW. "An evaluation of activation and implementation of the medical emergency team system." Awarded by:University of New South Wales. School of Anaesthetics, Intensive Care and Emergency Medicine, 2006. http://handle.unsw.edu.au/1959.4/25720.
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Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.
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Flippies, Emirenthia Emogin Elouise, and D. J. L. Venter. "The relationship between organisational contextual factors and clinical practice guideline implementation in private critical care units." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12583.
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Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.
11
Corbett, Gina M. "The Corbett Pain Scale : a multidimensional pain scale for adult intensive care patients /." VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1432.
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Emeka-Nweze, Chika Cornelia. "ICU_POC: AN EMR-BASED POINT OF CARE SYSTEM DESIGN FOR THE INTENSIVE CARE UNIT." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1499255523449397.
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Johnson, Alistair E. W. "Mortality prediction and acuity assessment in critical care." Thesis, University of Oxford, 2014. https://ora.ox.ac.uk/objects/uuid:2486465e-8fda-47a9-b82e-c0a93f4f1fc4.
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Accurate mortality prediction in intensive care units (ICUs) allows for the risk adjustment of study populations, aids in patient care and provides a method for benchmarking overall hospital and ICU performance. ICU risk-adjustment models are primarily comprised of an integer severity of illness score which increases with increasing patient risk of mortality. First published in the 1980s, the improvements to these scores primarily consisted of increasing the dimensionality of the model, and hence also increasing their complexity. This thesis aims to improve upon these models. First, the field is surveyed and the major models for risk-adjusting critically ill patient cohorts are identified including the acute physiology score (APS) and the simplified acute physiology score (SAPS). A key component of model performance is data preprocessing. The effect of preprocessing ICU data is quantified on a dataset of 8,000 ICU patients, and it is shown that after preprocessing to remove extreme values a logistic regression (LR) model performed competitively (AUROC of 0.8633) with the more complex machine learning model; a support vector machine (SVM) which had an AUROC of 0.8653. For validation, model development was repeated in a larger database containing over 80,000 patients admitted to 89 ICUs in the United States. Results were similar (AUROC of 0.8895 for the LR vs 0.8917 for the SVM) but showed the performance gain when using automated outlier rejection is less pronounced in well quality controlled datasets (0.8883 for LR without rejection). It is hypothesised from this that simpler models can perform competitively with more complicated models, while having a greatly reduced burden of data collection. A severity score is developed on the large multi-center database using a Genetic Algorithm and Particle Swarm Optimisation. The severity score, named the Oxford Acute Severity of Illness Score (OASIS), is shown to outperform the APS III (AUROC 0.837 vs 0.822) and perform competitively with APACHE IV when used as a covariate in a regression model (AUROC 0.868 vs 0.881). The severity score requires only 10 variables (58% as many as APS III), reducing the burden of quality control and data collection. These variables are routinely collected in critical care by continuous monitors and do not include comorbidities, diagnosis or laboratory measurements. The severity score is then externally evaluated in an American hospital and shown to discriminate well (AUROC 0.790 vs. 0.782 for the APS III) with excellent calibration. Finally, the severity score was evaluated in an English hospital and compared to other severity scores. OASIS again had excellent calibration and discrimination (AUROC 0.776 vs 0.750 for APS III) whilst requiring a much smaller number of variables. OASIS has many applications, including both simplifying data collection for studies and improving the risk assessment therein.
14
Williams, Teresa Ann. "Long-term outcomes for patients treated in the Intensive Care Unit (ICU) : a cohort study using linked data." University of Western Australia. School of Population Health, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0005.
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Royal Perth Hospital is the largest hospital in Western Australia and also has the largest intensive care unit (ICU) in the State. It was the first public hospital to provide intensive care services in Western Australia. This thesis examines the intermediateand long-term outcomes of patients admitted to the Royal Perth Hospital ICU between 1987 and 2002. Intermediate-term survival, defined as survival after discharge from hospital to one year and long-term survival, that exceeding one year after discharge, are important outcomes. Information on outcomes can be used by ICU staff in discussions with patients and their families and to inform policy decision-making and future research. The aim of this research was to examine one-year and long-term outcomes of patients admitted to the ICU between 1987 and 2002 and explore the factors that might be associated with the outcomes for 22,298 patients admitted to the ICU. A clinical ICU database was linked to morbidity and mortality databases by Data Linkage WA. A wide range of demographic and clinical factors were examined for their effect on outcome. These included age, sex, comorbidity, severity of illness, organ failure, ICU diagnostic groups, type of admission (medical, elective surgical and non-elective surgical), length of stay in ICU and era of admission (1987-1990, 1991-1994, 1995-1998, 1999-2002). Patients were followed-up to study end, 31st December 2003 or death if it occurred before study end, that is, up to 17 years after the index ICU admission. Kaplan Meier survival curves and Cox regression models were used to examine intermediate and long-term survival for patients who survived to hospital discharge. A comparison of admissions to hospital before and after the index ICU admission was made using descriptive statistics and logistic regression. Throughout the study period survival for the ICU cohort was shorter when compared to the Australian population. This was consistent throughout the follow-up period. The most important determinants of long-term survival were age, comorbidity, severity of illness and diagnostic group but the strength of association varied with the duration of follow-up. Although age, comorbidity and severity of illness increased among the critically ill survival improved over time. Hospital admissions were more frequent after a discharge from hospital that required an admission to ICU than before the index admission, even after adjusting for the ageing of the cohort. This study provides unique information about the survival and other outcomes of patients discharged from a hospital admission that included an ICU stay. The strength of this study lies in the follow-up to 17 years and the more comprehensive range of explanatory factors than in previous studies. This thesis demonstrates that follow-up studies after intensive care should be of sufficient duration to account for the changes that occur in survival over time and indicates the range of factors that should be taken into account when making comparisons of long-term survival.
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Love, Janine Ann. "Respiratory management of the mechanically ventilated spinal cord injured patient in a critical care unit." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008451.
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Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.
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Bell, Janet. "An investigation into the scope of practice of a registered critical care nurse in a private hospital." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16595.
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Thesis (MCur)--University of Stellenbosch, 2005.<br>ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often
shifts the parameters within which she or he practices. It is expected of a
skilled critical care nurse to be able to make independent decisions and take
action regarding patient care based on her or his knowledge and skills without
discounting the parameters of her or his scope of practice. Practice
experience has indicated that the critical care nurse is often uncertain about
whether her or his clinical activities are protected by the regulations provided
by the Nursing Council. This is more specifically true in the private hospital
industry where medical advice or assistance is not always easily available.
This situation led to the following research question:
Do the available professional and legal guidelines provide an appropriate
foundation to guide the practice of the registered critical care nurse in the
private hospital sector critical care environment?
A non-experimental descriptive study with a qualitative orientation was
conducted in 19 private hospitals in the Western Cape. Through nonprobability,
random sampling, 71 registered critical care nurses were included
in the study. A questionnaire was designed and validated to collect the data.
Quantitative data was analysed through Excel® while qualitative data was
analysed thematically.
It was found that the legal and professional guidelines in place at present do
provide a foundation for the clinical activities of critical care nursing in the
private hospital sector. It is suggested that it is rather the critical care nurses’
interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended)
that limits their practice as opposed to the wording of the regulations.
It is recommended that critical care nurses must determine nursing care
parameters based on patient need, using the regulations as a foundation for
critical, analytical and reflective practice rather than as a set of rules to be
followed.
Key words: Scope of practice, critical care practice, ICU nursing care, private
hospital nursing practice.<br>AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes
gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n
bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike
besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy
kennis en vaardighede, sal neem sonder om die parameters van haar of sy
bestek van praktyk te oorskry. Praktykondervinding het getoon dat die
kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy
optredes deur die Regulasies, soos deur die Raad op Verpleging
gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing
in die privaathospitaal-industrie waar geneeskundige advies en bystand nie
altyd maklik beskikbaar is nie. Die situasie het tot die volgende
navorsingsvraag aanleiding gegee:
Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag
om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die
privaatsektor- kritiekesorgomgewing te rig?
’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in
19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-,
toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges
in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer
om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed
terwyl kwalitatiewe data tematies ontleed is.
Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is,
‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges
in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige
se interpretasie van die Bestek van Praktyk (No.R.2598 of
30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die
bewoording van die regulasie self.
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Brown, Andrew Scott. "Differences in attitudes towards risk in the use of medical devices by doctors and nurses in an acute care setting : organisational, professional and personal dimensions." Thesis, Swansea University, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678287.
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Natt, B. S., J. Malo, C. D. Hypes, J. C. Sakles, and J. M. Mosier. "Strategies to improve first attempt success at intubation in critically ill patients." OXFORD UNIV PRESS, 2016. http://hdl.handle.net/10150/622528.
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Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
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Peng, Niang-Huei. "An exploration of the relationship between stress physiological signals and stress behaviors in preterm infants during periods of environmental stress in the intensive care unit." Diss., St. Louis, Mo. : University of Missouri--St. Louis, 2008. http://etd.umsl.edu/r2801.
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Kruger, Jeanne-Marie. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit." Thesis, Stellenbosch : University of Stellenbosch, 2006. http://hdl.handle.net/10019.1/1943.
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Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006.<br>INTRODUCTION: The primary objective was to determine whether acidified formulae (pH 3.5 and
4.5) decreased gastric and tracheal colonisation, as well as microbial contamination of the enteral
feeding delivery system, compared with a non-acidified control formula (pH 6.8) in critically ill
patients. Secondary objectives included tolerance of the trial formulae and mortality in relation to
the administration of acidified formulas.
DESIGN: The trial was a controlled, double-blinded, randomised clinical trial of three parallel
groups at a single centre.
METHOD: Sixty-seven mechanically ventilated, medical and surgical critically ill patients were
randomised according to their APACHE II scores and included in the trial. Patients received either
an acidified (pH 3.5 or 4.5) or control polymeric enteral formula via an 8-Fr nasogastric tube at a
continuous rate. Daily samples were taken for microbiologic analyses of the enteral formulae at
various stages of reconstitution and at 6-hour and 24-hour intervals during administration thereof
(feeding bottle and delivery set). Daily patient samples included nasogastric and tracheal
aspirates, haematological evaluation and gastro-intestinal tolerance. The trial period terminated
when patients were extubated, transferred from the ICU, enteral nutrition became contraindicated,
a patient died, or for a maximum of 21 days.
RESULTS: Gastric pH showed no significant difference (p = 0.86) between the 3 feeding groups
[pH 3.5 (n = 23), pH 4.5 (n = 23) and pH 6.8 (n = 21)] at baseline prior to the administration of
enteral formulae. After initiation of feeds, the gastric pH decreased significantly (p< 0.0001) in the
acidified formulae as compared to the control formula during the trial period. Patients who
received acidified enteral formulae (pH 3.5 and 4.5) had significantly less (p < 0.0001)
contamination from the feeding bottles and delivery systems in respect of Enterobacteriacea, and
Enterococcus., The more acidified group (pH 3.5) showed significantly less gastric contamination
(p = 0.029) with Enterobacteriacea, , but not for fungi. The 3.5 acidified group also had the lowest
gastric growth in terms of colony counts (≤104) of these organisms, but not for fungi, when
compared to the control group (≤105). Vomiting episodes were 22% and abdominal distension
12%, with a higher incidence in the control group. Adverse events occurred equally between the
groups with a higher, but not significantly different incidence of 37% in the control group and 32%
for the acidified groups. There was no evidence of gastro-intestinal bleeding in any patient.
Overall, the mortality rate in this trial was 6%, with 6.5% for the acidified groups (n=46) and 4.8%
for the control group (n=21), a statistically insignificant difference.
CONCLUSION: Acidified enteral formulae significantly decrease gastric colonisation by
preserving gastric acidity that decreases the growth of Enterobacteriaceaes organisms. Acidified
formulae significantly decrease bacterial contamination of the enteral feeding system (bottle and
delivery set) of Enterobacteriaceae and Enterococcus organisms. Acidified formulae are tolerated
well in critically ill patients.
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Hillman, Ken School of Medicine UNSW. "CONCEPTUALISATION, DEVELOPMENT AND IMPLEMENTATION OF THE MEDICAL EMERGENCY TEAM (MET) AS A SYSTEM OF MANAGEMENT TO IMPROVE OUTCOMES FOR SERIOUSLY ILL PATIENTS." Awarded by:University of New South Wales. School of Medicine, 2006. http://handle.unsw.edu.au/1959.4/30408.
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This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.
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Brooks, Robert School of Community Medicine UNSW. "Health related quality of life of intensive care patients: Development of the Sydney quality of life questionnaire." Awarded by:University of New South Wales. School of Community Medicine, 1998. http://handle.unsw.edu.au/1959.4/17465.
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This thesis has three main research aims. First the development of a questionnaire to measure HRQOL of ICU patients. Second, to examine a model of HRQOL proposed to assist with the development of the questionnaire. Third, to examine the HRQOL outcomes of patient after hospital discharge. The proposed model is based on a review of conceptual issues related to Quality of Life (QOL), Health Status and HRQOL. After a content analysis of a broad range of definitions of QOL, Health Status and HRQOL, QOL was defined as a dynamic attitude, continually being modified by experience. It is a function of the cognitive and affective appraisals of the discrepancies between domain specific perceptions and expectations. HRQOL was defined as an individuals cognitive and affective response to, or the QOL associated with, their health status. Health status was seen to consist of two health dimensions, physical and psychological health, with each dimension being composed of a number of component measures assessed subjectively. The developed questionnaire, the Sydney Quality of Life (SQOL) had good construct validity, based on substantial correspondence between qualitative and quantitative data, and internal consistency data (factor analysis and Cronbach's alpha). It had good concurrent validity in relation to the Sickness Impact Profile. The second order factor analysis of the SQOL suggested that health status may consist of three dimensions, physical health, positive mental health and negative mental health. The HRQOL model when formally examined, using Structural Equation Modelling (using LISREL), was not supported. However, exploratory modelling supported the separation of mental health into positive and negative components. The structure of HRQOL was different for patients than for the community from which they came. Patients QOL was determined largely by positive mental and physical health, whereas community members QOL was largely determined by negative mental health. Sixty three percent of patients at 12 months after discharge had significantly worse physical and functional health, lower satisfaction with their lives, lower positive affect and poorer QOL. Overall, mental health adapts rapidly to the impact of serious physical ill health and hospitalisation. Implications for clinical practice are examined.
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Majó, Roviras Carme. "Anàlisi dels problemes ètics de la limitació de l'esforç terapèutic a la Unitat de Cures Intensives." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/394008.
Full textAbstract:
La funció de les Unitats de Cures Intensives consisteix en donar suport a la insuficiència dels òrgans de pacients greument malalts. En la gran majoria de pacients, s'aconsegueix revertir la situació de risc vital, però en contrapartida també estem parlant d'un dels serveis hospitalaris que té més mortalitat estadísticament i que ha de limitar les tècniques en una part important dels casos. Atenent el principi de beneficència, un dels principis de la ètica mèdica, la limitació es pot produir abans d'aplicar aquestes tècniques ja que d'entrada es determina que no es podrà oferir cap benefici terapèutic al malalt, però un cop ja s'han aplicat aquestes tècniques també s'han de limitar ja que deixen de ser beneficients més endavant. Aquestes possibilitats han evidenciat cada vegada més aspectes relacionats amb tractaments desproporcionats.
S'ha constatat que els professionals solen tenir dos dubtes ètics relacionats amb la limitació de l'esforç terapèutic:
1. Un té a veure en determinar com i en quin moment l'assistència als malalts ha d'agafar una altra dimensió i passar de la vessant terapèutica a la vessant pal•liativa i de confort evitant que els tractaments resultin fútils o desproporcionats.
2. l l'altre, amb el grau d'adequació dels tractaments i de cures al final de la vida.
Per poder fer una aportació respecte al debat actual sobre aquest tema, en aquesta tesi s'analitzen tots els casos de LET detectats a la Unitat de Cures Intensives de L'Hospital Universitari Dr. Josep Trueta de Girona, a partir de la sessió clínica de cada dia on es recull, en un registre, l'evolució de tots els pacients distingint els que s'aplicà la Limitació de L'Esforç Terapèutic.
Es tracta d'un estudi retrospectiu a través de la revisió de les Històries Clíniques dels pacients a qui es va aplicar una LET. L'estudi té l'objectiu d'actualitzar el debat des de l'estadística i la casuística i per aquesta raó, la tesi parteix d' un marc empíric A la primera part, es donen les dades estadístiques generals sobre la LET a la UCI des del dia 1 d'octubre de 2010 i el dia 30 setembre de 2011, un any en total. A la segona part, es realitza una anàlisi qualitativa dels 77 casos de LET detectats. Finalment, es fa una síntesi dels resultats obtinguts amb una valoració des del principis de la bioètica i s’indiquen unes propostes de millora.<br>In order to make a contribution with respect to the present debate on the subject of Limitation of life-sustaining treatments, the evolvement of patients is analyzed from daily clinical session registries, distinguishing those where limitation of life-sustaining was applied in the Intensive Care Unit (ICU) of the University Hospital Dr. Josep Trueta of Girona.
One is a retrospective study through the revision of the medical histories of patients where limitation of life-sustaining treatments was applied. The objective of this study is to bring up to date the debate from the statistical and casuistry, and therefore, the thesis is part of an empirical standpoint. In the first part, the general statistical data on limitation of life-sustaining treatments in the ICU is from October 1, 2010 to September 30, 2011, one year altogether. In the second part, a qualitative analysis of the 77 cases where limitation of life-sustaining treatments was applied is realized. Finally, a summary of the results obtained along with an evaluation of bioethical principles and some propositions for improvement are indicated.
The objective of the doctoral thesis apart from a bioethical standpoint is to find the tools in intensive medicine to adequately combine the therapeutical with support, care and comfort:
1. - How the decisions of limitation of life-sustaining treatments are carried out day to day in the ICU of the Trueta Hospital of Girona and what are the ethical problems that arise.
2. - Determination of what type or what profile of a patient with limitation of life-sustaining treatments in the ICU has. On one hand, how is this patient, what characteristic defines them; age, sex, pathology or reason for admission, origin, number of entered days, complications. On the other hand, questions regarding the principle of autonomy, competency, will and expectations, representatives of the patients, professional opinions, family members and social-economic quality of life, factors, the personal antecedents of interest.
3. - Detect strong and weak points, taking into account, as a last objective, to contribute to the qualitative improvement of care and attention.
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McMoon, Michelle. "Patients' Perceptions of Quality of Life and Resource Availability After Critical Illness." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7558.
Full textAbstract:
Physical, psychological, and social debilities are common among survivors of critical illness. Survivors of critical illness require rehabilitative services during recovery in order to return to functional independence, but the structure and access of such services remains unclear. The purpose of this qualitative study was to explore the vital issues affecting quality of life from the perspective of critical illness survivors and to understand these patients' experiences with rehabilitative services in the United States. The theoretical framework guiding this study was Weber's rational choice theory, and a phenomenological study design was employed. The research questions focused on the survivors' experiences with rehabilitative services following critical illness and post-intensive care unit quality of life. Participants were recruited using purposeful sampling. A researcher developed instrument was used to conduct 12 semistructured interviews in central North Carolina. Data from the interviews were coded for thematic analysis. The findings identified that aftercare lacked unity, was limited by disparate information, and overuses informal caregivers. In addition, survivors' recovery depended on being prepared for post-intensive care unit life, access to recovery specific support structures, and the survivors' ability to adapt to a new normalcy. Survivors experienced gratitude for being saved, which empowered them to embrace new life priorities. The implications for social change include improved understanding of urgently needed health care policies to provide essential therapies and services required to support intensive care unit survivors on their journey to recovery.
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Corrêa, Volpini Bruna. "Development of an Ambient Intelligence Environment to improve Patient Safety in Critical Care." Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/673228.
Full textAbstract:
In the late 1990's, when sophisticated personal computers and electronic devices with miniaturized sensors were being mass produced, the concept of ambient intelligence (AmI) emerged. An environment that has AmI is a space containing objects which includes technologies that are not visible to users, and which generates intelligent responses when appropriate. When people interact with an AmI environment, they intuitively use technologies according to their own needs and gain more awareness of their actions, thereby improving their quality of life, comfort, and empowerment.
Currently, healthcare professionals work inside a complex adaptive system in which the clinical environment and the health status of patients vary dynamically, and resources are limited. This can generate an increasing number of adverse events as well as medical errors and consequently patients are more exposed to potential harm during a hospital stay. Many researchers are creating new AmI tools to overcome these challenges. This is especially important in intensive care units (ICUs), where there are seriously ill patients who need advanced infrastructure and equipment to receive continuous clinical monitoring and treatment in as safe a way as possible. Three out of every ten patients in an ICU suffer some type of clinical safety issue, which puts their lives at risk.
In this context, the main aim of the work I present in this thesis is to develop an AmI environment for improving the efficiency of processes related to patient safety in ICUs. I have written this thesis with the collaboration of the clinical and engineering
team of the Smart ICU at the Hospital Cl(n
ic in Barcelona (HCB). That AmI
environment is equipped mainly with technologies related to the Internet of Things (IoT) that provide an adaptive and dynamic distribution of clinical information based on the role and location of each professional as well as the clinical health status of patients.
I divided the development of this thesis into three phases. Firstly, I designed, built, and tested a prototype to simulate the AmI environment in a laboratory setting, considering the main patient safety issues which arise in ICUs. I considered 5 patient safety issues: a code blue, a code red, a code pink, control of nosocomial infections and drug-related errors. Secondly, that prototype was adapted and implemented in a Smart ICU at HCB. Thirdly, I collected and analysed data generated by the AmI. It is important to highlight that part of the data collection and analysis related to the AmI environment took place during the SARS-CoV-2 epidemic (Covid- 19).
To summarize, my thesis evaluates the efficiency of the use of new technologies to improve patient safety processes in critical care. It improves clinical and educational standards in terms of patient safety processes at the unit concerned. Moreover, it enables quantification of events related to patient safety as well as heightening awareness of them.<br>A finales de la década de 1990, cuando las computadoras personales y los dispositivos electrónicos se producían en masa, el concepto de inteligencia en el entorno (AmI – Ambient Intelligence en inglés) surgió. Un entorno que contiene AmI es un espacio con objetos que incluyen tecnologías, invisibles para los usuarios, y que les generan respuestas inteligentes cuando sea necesario.
Actualmente, los profesionales sanitarios están trabajando dentro de un sistema complejo adaptativo en el que el entorno clínico y el estado de salud del paciente varían dinámicamente. Esto es especialmente importante en las Unidades de Cuidados Intensivos (UCIs), donde hay pacientes gravemente enfermos que necesitan infraestructuras y equipos avanzados para recibir monitorización de la forma más segura posible.
En este contexto, el objetivo principal del trabajo que presento en esta tesis es desarrollar un entorno AmI para mejorar la eficiencia en los procesos relacionados con la seguridad del paciente en las UCIs. He elaborado esta tesis con la colaboración del equipo de la UCI inteligente del Hospital Clínic de Barcelona (HCB). El desarrollo de esta tesis se ha dividido en tres fases. En primer lugar, he diseñado, construido y probado un prototipo para simular el entorno AmI en un escenario de laboratorio considerando los principales problemas de seguridad clínica que ocurren en las UCIs. En segundo lugar, este prototipo ha sido adaptado e implementado en una UCI inteligente del HCB. En tercer lugar, he recogido y analizado los datos generados por el entorno inteligente.
En conclusión, mi tesis evalúa la eficiencia del uso de nuevas tecnologías para mejorar los procesos de seguridad clínica en cuidados críticos, mejora los estándares clínicos y educativos sobre los procesos de seguridad del paciente en esta unidad y, finalmente, permite cuantificar los eventos relacionados con la seguridad clínica, así como ganar más conciencia sobre ellos.
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Van, Niekerk Hester Susanna. "The effect of a low volume pharmaconutrition supplement with antioxidants and glutamine (Intestamine®) administration to critically ill patients on the prevalence of infection, ventilation requirements and duration of intensive care unit stay : a pilot study." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5339.
Full textAbstract:
Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010.<br>ENGLISH ABSTRACT: Introduction
Complications of severe infection or acute trauma include a cascade of
immunological dysfunctions known as SIRS (Systemic Inflammatory Response
Syndrome), that affect response to treatment, prolonging and complicating the
course of illness and jeopardizing clinical outcome. Timing and the nature of
nutritional support in the Intensive Care Unit (ICU) setting may influence this
process. Against this background, and despite some trials demonstrating
beneficial clinical outcomes for the use of immune-modulating diets (IMD), the
findings of the US summit on immune-enhancing enteral therapy concluded that
the currently available enteral immune-enhancing formulas are “first-generation
products” which may not be appropriate in patients with SIRS or severe sepsis.
This highlights a need for alternative nutritional products that target the specific
needs of this patient population. As such, Intestamin® is designed for use in
severely stressed patients as an immune-modulating enteral feed supplement
which aims to improve maintenance of gut barrier integrity and immune
response.
Aim
The aim of this pilot study was to investigate the effect of Intestamin®
administration to critically ill patients, and in particular, to determine if
administration would impact on nosocomial infections, ventilation days and the
length of stay in the ICU.
Methods
The study design was an open label, retrospective case control, analytical study,
of patients admitted to the ICU in The Bay Hospital, Richards Bay, between
January 2002 and November 2003, who received Intestamin®. Patients were
selected for the study from post-surgery and post-trauma patients at high risk of
sepsis and SIRS, and critically ill patients with manifested SIRS or severe sepsis.
Development of respiratory and urinary sepsis was used as surrogate markers
for progression to severe sepsis and SIRS. Additionally, duration of ventilation and ICU stay were considered representative of the response to treatment and
degree of clinical complications.
Results
The findings of the study demonstrated a significant difference in the rates of
respiratory infection(p=0.05), positive sputum and tracheal aspirate
cultures(p=0.03) and urinary catheter tip cultures(p=0.04). with statistically lower
rates in the intervention group compared to the control group. There were no
significant differences in the rates of urinary tract infection, septicaemia or in
combined sepsis rates between the two groups. There were statistically
significant higher rates of positive pus cell counts in the sputum(p=0.003) and
urine(p=0.01) in the intervention group, compared to the control group. No
corresponding reduction in ventilation days or ICU stay was observed.
Conclusion
In this patient population, early enteral nutrition with specially formulated IMD,
(Intestamin®), did result in a significant reduction in respiratory infections, but not
in other types of sepsis, ICU or ventilator days in critically ill ICU patients. This
positive finding in some, but not all endpoints collected, may reflect confounding
factors in the small patient population or the choice of clinical endpoints, rather
than a genuine limitation in the benefit. IMD remains a tantalizing and
scientifically plausible intervention in this patient population, with larger clinical
trials necessary to confirm outcomes. The study supports the safe use of
Intestamin by the nasojejenal route in this patient population.<br>AFRIKAANSE OPSOMMING:Inleiding
Komplikasies van erge infeksie of akute trauma sluit ‘n kaskade van
immunologiese disfunsie in, bekend as SIRS (Sistemiese Inflammatoriese
Respons Sindroom), wat die respons op behandeling affekteer, die verloop van
siekte verleng en kompliseer asook die kliniese uitkoms beïnvloed.
Tydsberekening en die aard van die voedingsondersteuning in die Intensiewe
Sorg Eenheid (ISE) mag hierdie proses beinvloed. Teen hierdie agtergrond, en
ten spyte van sommige studies wat die voordelige kliniese uitkoms vir die gebruik
van immuun-modulerende diete (IMD) toon, het die “US summit” oor immuunverbeterde
enterale terapie tot die gevolgtrekking gekom dat die huidige
beskikbare enterale immuun-verbeterde formules, “eerste-generasie” produkte is,
wat moontlik nie toepaslik is vir pasiente met SIRS of erge sepsis nie. Dit
beklemtoon ’n behoefte aan alternatiewe voedingsprodukte wat die spesifieke
behoeftes van die genoemde pasient populasie teiken. Intestamin® is ontwerp vir
gebruik in erge gestresde pasiente as ‘n immuun-modulerende enterale
voedingssupplement doelgerig om spysverteringskanaal integriteit te onderhou
en immuniteit te verbeter.
Doel
Hierdie loodsstudie se doel was om die effek van Intestamin® toediening aan
kritiek siek pasiente te ondersoek, spesifiek om vas te stel of die toediening
impakteer op nosokomiale infeksies, ventilasie dae en dae in ISE.
.Metode
Die studie ontwerp was ‘n oop, retrospektiewe, geval kontrole, analitiese studie
van pasiente opgeneem in die ISE van The Bay Hospital, Richardsbaai, tussen
Januarie 2002 en November 2003, wat Intestamin® ontvang het. Pasiënte is
geselekteer vir die studie uit post-chirurgies en post-trauma pasiente wat hoë
risiko was vir sepsis en SIRS, en kritiek siek pasiente wat reeds manifisteer het
met SIRS of erge sepsis. Ontwikkeling van respiratoriese en urinêre sepsis is
gebruik as surrogaat merkers vir die progressie na erge sepsis en SIRS. Addisioneel is duur van ventilasie en ISE verblyf beskou as verteenwoordigend
vir die respons op behandeling en die graad van kliniese komplikasies.
Resultate
Die bevindinge van die studie het betekenisvolle verskille aangedui in die
voorkoms van respiratoriese infeksies(p=0.05), positiewe sputum en trachiale
aspiraatkulture(p=0.03) en urine kateterpunt-kulture(p=0.04) met statistiese laer
voorkoms in die intervensie groep in vergelyking met kontroles. Geen statistiese
verskille in die voorkoms van urineweg-infeksies, septisemia of in gekombineerde
sepsis voorkoms tussen die twee groepe is gevind nie. Daar was statistiese
betekenisvolle hoër voorkoms van etterselle hoeveelhede in die sputum(p=0.030
en uriene(p=0.01) van die intervensie groep in vergelyking met die kontrole
groep. Geen ooreenkomstige vermindering in ventilasie dae of ISE verblyf is
opgemerk nie.
Gevolgtrekking
In hierdie pasiënt populasie, het vroeë enterale voeding met spesifieke
geformuleerde IMD (Intestamin®), ‘n beduidende vermindering in respiratoriese
infeksies getoon, maar nie in ander tipes sepsis, ISE of ventilasie dae by kritiek
siek pasiente nie. Hierdie positiewe bevindinge in sommige. maar nie al die
versamelde eindpunte nie, reflekteer moontlike bydraende faktore in die klein
pasiënt populasie of die keuse van kliniese eindpunte, eerder as a ware
beperking in die voordele. IMD bly steeds ‘n uitdagende en wetenskapilik
uitsonderlike intervensie in hierdie pasiënt populasie, wat groter kliniese studies
benodig om die uitkoms te bevestig. Die studie ondersteun die veilige gebruik
van Intestamin® via die nasojejenale roete in kritiek siek pasiënte.
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Jarden, Rebecca Jane. "Gastric residual volumes in the adult intensive care patient : a systematic review : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Nursing (Clinical) /." ResearchArchive@Victoria e-Thesis, 2009. http://hdl.handle.net/10063/1188.
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Burk, Ruth. "Predictors of agitation in the critically ill." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2985.
Full textAbstract:
BACKGROUND: Agitation is a common complication in the intensive care unit (ICU) manifested in behavior and actions that range from simple apprehension or anxiety to frankly combative behavior.5 Agitation is associated with significant adverse outcomes.1-3 Studies report up to 71% of ICU patients have some degree of agitation during their ICU stay and that agitation is observed 32% of the time.3;4 Potential causes of agitation in critically ill patients are numerous; however, data about factors that predict agitation are limited. OBJECTIVE: The specific aim of this study was to identify predictors of agitation on admission to the ICU as well as within 24 hours prior to the first agitation event. DESIGN: Retrospective medical record review. SETTING: Two adult critical care units, Medical Respiratory ICU (MRICU) and Surgical Trauma ICU (STICU) in an urban university medical center. SUBJECTS: A convenience sample of 200 critically ill adult patients, all older than 18 years of age, consecutively admitted to a MRICU and STICU, admitted for longer than 24 hours, over a two month period. METHODS: Risk factors for agitation were identified from literature review as well as from expert consultation. Data were collected during the first 5 days of ICU stay. Agitation was identified using the documented Richmond Agitation-Sedation Scale or notation of “agitation” in the medical record. RESULTS: Of the sample 56.5% were male, 51.5% Euro-American, with mean age 55.5 years (±16.4). Independent predictors of agitation on admission to the ICU were: past medical history of illicit substance use, height, both the Sequential Organ Failure Assessment respiratory and central nervous system subscores, and use of restraints. Predictors of agitation within 24 hours prior to the first agitation event were: percent of hours using restraints, percent of hours using mechanical ventilation, number of genitourinary catheters, and blood pH and albumin. CONCLUSIONS: Use of these empirically based data may allow care providers to identify those at risk as well as predict agitation. Elimination or reduction of agitation in the ICU would improve patient safety and reduce hospitalization resulting in significant savings to healthcare. Reference List (1) Woods JC, Mion LC, Connor JT et al. Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes. Intensive Care Med 2004;30:1066-1072. (2) Jaber S, Chanques G, Altairac C et al. A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest 2005;128:2749-2757. (3) Fraser GL, Prato BS, Riker RR, Berthiaume D, Wilkins ML. Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU. Pharmacotherapy 2000;20:75-82. (4) Gardner K, Sessler CN, Grap MJ. Clinical factors associated with agitation. Am J Crit Care 2006;15:330-331. (5) Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325-1329.
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Elías, Maya N. "The Relationship Between Sleep Quality and Motor Function in Hospitalized Older Adult Survivors of Critical Illness." Scholar Commons, 2018. https://scholarcommons.usf.edu/etd/7616.
Full textAbstract:
The primary, descriptive aim of this dissertation was to describe the nighttime sleep quality of previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the intensive care unit (ICU) to a medical-surgical floor. The secondary, exploratory aim was to examine the relationships between post-ICU sleep efficiency (SE) and wake after sleep onset (WASO) with grip strength in previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the ICU.
The study included 30 adults ages 65 and older (11 women, 19 men; age 71.37 ± 5.35, range 65-86 years), who were functionally independent at home prior to hospitalization, mechanically ventilated during their ICU stay, and were within 24-48 hours of transfer out of ICU to a medical-surgical floor at Tampa General Hospital, a level 1 trauma center. Subjects wore an actigraph monitor on the dominant wrist (Actiwatch Spectrum) to monitor sleep over two consecutive nights. Parameters of post-ICU sleep quality included total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NA). The outcome measure of motor function was dominant hand grip strength, assessed by the National Institutes of Health Toolbox Motor Battery Grip Strength Test. Sleep data collected between nighttime hours (9:00 PM to 9:00 AM) on both nights were analyzed. For the descriptive aim, means for each sleep parameter and clinical characteristics were reported. For the exploratory aims, multiple regression analyses examined the individual associations between mean sleep parameters (SE and WASO) and grip strength.
Study subjects had a mean SE of 63.24 ± 3.88% and spent 135.39 ± 9.94 minutes awake after sleep onset. The mean TST among subjects was 7.55 ± 2.52 hours, ranging from 2.02 to 10.84 hours of sleep, out of the 12 hours of total time in bed. A total of 6 (20%) subjects slept less than 5 hours each night, and a total of 6 (20%) subjects slept greater than 10 hours each night. The mean SL among study subjects was 42.57 minutes, and ranged from 0.0 to 237.75 minutes. Overall, subjects’ average NA was 78.28 ± 26.39, ranging from 35 to 136 awakenings.
In multiple regression analysis, SE was significantly and negatively associated with grip strength, after adjusting for potential confounding factors. The model predictors explained 80.8% of the variance in grip strength, [R2 = .808, F(10, 15) = 6.324, p = .001]. Higher SE independently predicted worse grip strength (β = -0.326, p = .036). Further, among the tertiles of subjects with moderate or high TST (sleep duration ≥ 6 hours, n = 23), there remained a significant, negative association between SE and grip strength. The predictors explained 73.7% of the variance in grip strength, [R2 = .737, F(5, 15) = 8.416, p = .001]. Higher SE independently predicted worse grip strength among the subset of subjects with moderate or high sleep duration (β = -0.296, p = .046). Among the two quartiles of subjects with moderate-high or high WASO (≥ 120 minutes spent awake after sleep onset, n = 16), there was a significant, negative association between WASO and grip strength, after adjusting for covariates. The model indicated that the predictors explained 91.4% of the variance in grip strength [R2 = .914, F(6, 8) = 14.134, p = .001]. Greater WASO independently predicted worse grip strength (β = -0.276, p = .04). Finally, the effects of sex and preexisting obstructive sleep apnea (OSA) on grip strength were individually examined. Higher SE independently predicted worse grip strength among male subjects (β = -0.353, p = .039), as did preexisting OSA (β = -0.493, p = .033).
In summary, objectively measured sleep quality was disturbed among previously mechanically ventilated, hospitalized older adults, even after transfer out of ICU to a medical-surgical floor. Longer TST and greater SE predicted worse grip strength among these frail patients who were previously independent, community dwelling older adults. Among the subjects with more severely fragmented sleep, WASO also independently predicted weaker grip strength. As poor grip strength is an indicator of ICU-acquired weakness, optimal sleep duration and less sleep disturbances may be crucial in prevention of worse functional outcomes and new institutionalization. Additional research is needed to discern the temporality of associations between sleep quality and motor function among older adult survivors of critical illness.
30
Beraldo, Carolina Contador. "Prevenção da pneumonia associada à ventilação mecânica: revisão integrativa." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-06082008-154159/.
Full textAbstract:
A pneumonia associada à ventilação mecânica (PAVM) é uma infecção freqüente nas Unidades de Terapia Intensiva (UTI), acarretando aumento no período de hospitalização, nos índices de morbimortalidade e com repercussão significativa nos custos. A implementação de medidas específicas para a prevenção da PAVM é baseada em diretrizes para a prática clínica, elaboradas por órgãos governamentais e associações de especialistas. Nesse sentido, é importante destacar a necessidade de atualização permanente dos profissionais da saúde. Frente ao exposto, objetivouse avaliar e descrever as evidências científicas disponíveis sobre as práticas de prevenção da PAVM, em pacientes adultos, hospitalizados em UTI. A prática baseada em evidências representou o referencial teórico-metodológico. E, para a obtenção das evidências de Níveis I e II, publicadas posteriormente à diretriz do CDC, realizou-se a revisão integrativa da literatura nas bases de dados MEDLINE, LILACS, CINAHL e Biblioteca Cochrane. Totalizou-se 23 publicações, agrupadas nas categorias temáticas: 5 (22%) higienização bucal, 7 (30%) aspiração de secreções, 5 (22%) umidificação das vias aéreas, 3 (13%) posicionamento do paciente e 3 (13%) diretrizes para a prática clínica. O uso da clorexidina na higienização bucal de pacientes sob ventilação mecânica diminuiu a colonização da orofaringe, o que pode reduzir a incidência de PAVM. Em adição, a aspiração da secreção subglótica e a terapia cinética mostraram-se medidas eficazes na prevenção da PAVM. Por outro lado, o uso do sistema fechado para a aspiração endotraqueal, a umidificação das vias aéreas com o dispositivo HME (heat and moisture exchanger), o controle da pressão do balonete do tubo endotraqueal, bem como, o posicionamento semirecumbente do paciente não apresentaram impacto na prevenção da PAVM e configuram como questões controversas. Assim, outras pesquisas são necessárias, especialmente, para elucidar questionamentos e implementar novas tecnologias acerca das medidas de prevenção da PAVM, o que sem dúvida repercutirá na qualidade da assistência de pacientes submetidos à ventilação mecânica.<br>Ventilator-associated pneumonia (VAP) is a common infection in the Intensive Care Unit (ICU), which leads to a longer period of hospitalization, higher rates of morbidmortality and a significant repercussion on the costs. The implementation of specific measures to prevent VAP is based on clinical practice guidelines elaborated by governmental organizations and expert committees. Thus, it is important to stand out the permanent actualization of health care professionals. Therefore, this study aimed to evaluate and describe the available scientifical evidences on VAP prevention practices in adult patients hospitalized in the ICU. The evidence based practice represented the theoretical-methodological reference. And, to obtain the evidences Levels I and II, published after the CDC guideline, an integrative review of the literature of MEDLINE, LILACS, CINAHL and Cochrane Library databases was realized. A total of 23 publishing grouped in categories: 5 (22%) oral hygiene, 7 (30%) aspiration of secretions, 5 (22%) airways moisturizing, 3 (13%) patient positioning and 3 (13%) clinical practice guidelines. The use of chlorhexidine in the oral hygiene of the mechanical ventilated patients decreased the oropharyngeal colonization, which may decrease VAP incidence. Besides, the subglottic secretions drainage and the kinetic therapy proved to be efficient on VAP prevention. However, the use of the closed system to the endotracheal aspiration, moisturizing the airways with HME (heat and moisture exchanger), the control of the pressure of the endotracheal tube cuff as well as the semirecumbent positioning of the patient, did not present any impact on the VAP prevention and are controversial matters. Thus, further researches are required mainly to clarify some questions and implement new technologies on measures to prevent VAP, which will certainly reflect on the quality of the assistance given to patients on mechanical ventilation.
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Salah, Heba. "Muscle Wasting in a Rat ICU Model : Underlying Mechanisms and Specific Intervention Strategies." Doctoral thesis, Uppsala universitet, Klinisk neurofysiologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-328596.
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Critical care has undergone several developments in the recent years leading to improved survival. However, acquired muscle weakness in the intensive care unit (ICU) is an important complication that affects severely ill patients and can prolong their ICU stay. Critical illness myopathy (CIM) is the progressive decline in the function and mass of the limb muscles in response to exposure to the ICU condition, while ventilator-induced diaphragm dysfunction (VIDD) is the time dependent decrease in the diaphragm function after the initiation of mechanical ventilation. Since the complete underlying mechanisms for CIM and VIDD are not completely understood, there is a compelling need for research on the mechanisms of CIM and VIDD to develop intervention strategies targeting these mechanisms. The aim of this thesis was to investigate the effects of several intervention strategies and rehabilitation programs on muscle wasting associated with ICU condition. Moreover, muscle specific differences in response to exposure to the ICU condition and different interventions was investigated. Hence, a rodent ICU model was used to address the mechanistic and therapeutic aspects of CIM and VIDD. The effects of heat shock protein 72 co-inducer (HSP72), BGP-15, on diaphragm and soleus for rats exposed to different durations of ICU condition was investigated. We showed that 5 and 10 days treatment with BGP-15 improved diaphragm fiber and myosin function, protected myosin from posttranslational modification, induced HSP72 and improved mitochondrial function. Moreover, BGP-15 treatment for 5 days improved soleus muscle fibers function, improved mitochondrial structure and reduced the levels of some ubiquitin ligases. In addition to BGP-15 treatment, passive mechanical loading of the limb muscles was investigated during exposure to the ICU condition. We showed that mitochondrial dynamics and mitophagy gene expression was affected by Mechanical silencing while mechanical loading counteracted these effects. Our investigation for other pathways that can be involved in muscle wasting associated with ICU condition showed that the Janus kinase 2/ Signal transducer and activator of transcription 3 (JAK2/STAT3) pathway is differentially activated in plantaris, intercostals and diaphragm. However, further studies are required with JAK2/STAT3 inhibitors to fully examine the role of this pathway in the pathogenesis of CIM and VIDD prior to translation to clinical research.
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Holgersson, Ann. "Sjuksköterskors upplevelser av hur arbetsprestationen påverkas av buller och störande ljud." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20203.
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Ljudnivån på intensivvårdsavdelningen är hög. Övervakningsutrustning och medicinskteknisk apparatur bidrar till bullret med sina larm, patientgruppen på intensivvårdsavdelningen är mycket personalkrävande och den höga personaltätheten bidrar till den höga ljudnivån. Forskning visar att buller påverkar arbetsprestationen och kan medföra att det blir svårare att genomföra en uppgift. Mänskligt tal är mer distraherande än annat buller även vid låga ljudnivåer. Syftet med studien är att beskriva hur sjuksköterskor inom intensivvård upplever att buller påverkar arbetsprestationen. Tre sjuksköterskor intervjuades och data analyserades med kvalitativ innehållsanalys enligt Lundman och Hällgren Granheim (2004, 2008). I resultatet framkom att trötthet, splittring, störning, ständig larmberedskap, stress och oro är faktorer som de intervjuade sjuksköterskorna anser påverkar arbetsprestationen. De intervjuade sjuksköterskorna beskriver att de upplever att bullret splittrar deras koncentration och stör deras uppmärksamhet. Sjuksköterskorna beskriver en oro att bullerstörningen ska leda till att fel ska begås och att patienten ska störas av bullret, vilket bidrar till att öka stressen. Personalens prat bidrar till en stor del av bullret och de intervjuade sjuksköterskorna uppger att de höga ljudnivåerna är något som ofta diskuteras på den aktuella arbetsplatsen. Resultatet av studien kan leda till att bullret i intensivvårdssjuksköterskors arbetsmiljö uppmärksammas vilket kan bidra till en bättre arbetsmiljö med bättre förutsättningar för en god kommunikation som i sig kan geett ökat välbefinnande och därmed en bättre hälsa för såväl personal som patient.<br>Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård
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Levinsson, Agnes, and Lisa-Rebecka Willén. "Kommunikation som berör : En observationsstudie om sjuksköterskans kommunikation med närstående inne på patientrummet på IVA." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20236.
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Patients in intensive care are often intubated, and therefore unable to speak, which leads to difficulties in communication. The ICU is a very stressful environment and can be experienced as foreign and frightening by both patients and their close ones. The ICU nurse’s caring responsibilities includes both the care of the critically ill patient and the support of relatives who are often in shock. This balance is not always straightforward, and acting professionally in both instances can lead to problems. The professional competence of an ICU nurse has been described as a calm surface, beneath which rages a conflict between medical and ethical issues. As such, communicating professionally with relatives is a challenge that rivals the nurse’s medical responsibilities.The aim of the study was to describe the significance of the nurse's communication with close relatives in the ICU patient room.The study was conducted using a qualitative and inductive approach. A non-participant, semi-structured, observational method was used. Seven observations were conducted.The results of the study are presented in five categories: to prioritise attention; be available for relatives; listen, inform, be sensitive and responsive; to value the meeting and to juxtapose between compassion and objectivity. We have found that the nurse possess the power to make a difference in how the relation between the nurse and close ones turns out and also that several factors can affect their relation.<br>Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård
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Bosch, Alcaraz Alejandro. "Confort y disconfort en el paciente crítico pediátrico. Adaptación transcultural y validación de la escala Comfort Behavior Scale." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/669228.
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INTRODUCCIÓN: El paciente crítico pediátrico desea ser confortado dentro de los contextos estresantes donde se lleva a cabo su atención sanitaria. Aún así, el manejo del confort en las unidades de críticos es uno de los aspectos más complicados de llevar a cabo por parte del equipo asistencial que atiende a estos niños.
OBJETIVOS: (1) Adaptar transculturalmente y validar al español la escala Comfort Behavior Scale desarrollada por van Dijk et al.; (2) determinar sus propiedades métricas; (3) analizar el grado de disconfort de los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátrica de un hospital de tercer nivel asistencial y (4) determinar las variables sociodemográficas y clínicas que influyen en el grado de disconfort.
TIPO DE ESTUDIO: Psicométrico y observacional, analítico y transversal.
MATERIAL Y MÉTODO: La Comfort Behavior Scale fue transculturalmente adaptada mediante el método de traducción y retraducción y validado su contenido por un panel de expertos y dos grupos de discussion que analizaron cualitativamente las características semánticas de la misma. Posteriormente, para determinar las propiedades métricas del instrumento se administró la escala a 311 pacientes ingresados en una unidad de cuidados intensivos de 18 camas de un hospital de tercer nivel asistencial. Un equipo de 10 enfermeras llevó a cabo la determinación del grado de disconfort empleando la Comfort Behavior Scale - Versión española una vez por turno (mañana, tarde y noche) y durante dos días consecutivos.
RESULTADOS: La Comfort Behavior Scale - Versión española obtuvo un índice de validez de contenido de 0,87. El coeficiente Alfa de Cronbach fue de 0,715. La escala está formada por tres factores con dos ítems cada uno de ellos: i) alerta y movimiento físico; ii) calma-agitación y respuesta respiratoria-llanto, y iii) tono muscular y tensión facial. El
49,8% (n=155) de los pacientes estaban con ausencia de disconfort versus el 50,2 (n=156) que lo padecían. Se observó una correlación negativa y significativa entre el disconfort y los días de estancia (Rho= 0,16; p=0,02), por tanto, a más estancia menos disconfort. Al analizar la relación entre el disconfort y la variable edad se observó una correlación positiva y con significación (Rho=0,230; p<0,001); a más edad más disconfort. Al comparar los niños que recibían sedoanalgesia (n=205) se observaron puntuaciones de disconfort de 10,77±2,94, en comparación con los que no la recibían (n=106) que obtuvieron puntuaciones de 11,96±2,80, estableciéndose relación estadísticamente significativa (X2=-4,05; p<0,001).
CONCLUSIONES: La Comfort Behavior Scale - Versión española es capaz de determinar el grado de disconfort del paciente crítico pediátrico. La práctica clínica diaria debe incluir la determinación del grado de disconfort y planificar actividades encaminadas a mejorarlo, especialmente en determinados grupos etarios y en pacientes críticos que no están recibiendo sedoanalgesia.<br>INTRODUCTION: Management of the comfort of critically ill paediatric patients in an intensive care unit is one of the most difficult challenges for healthcare professionals.
AIMS: (1) To transculturally validate the Comfort Behavior Scale developed by van Dijk et al. (2000) into Spanish; (2) to determine its measurement properties in paediatric critical care patients; (3) to analyze the degree of discomfort of patients admitted to the paediatric intensive care unit of a third-level hospital and (4) to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by the critically ill paediatric patient.
DESIGN: Psychometric and descriptive, observational and cross-sectional study.
METHODS: The Comfort Behavior Scale was transculturally adapted with the forward/backward translation method and validated by a panel of experts and two discussion groups which qualitatively analysed the semantic characteristics of the scale. Afterwards, the instrument was administered to 311 patients admitted to an eighteen- bed critical care unit of a third level paediatric hospital to determine its measurement properties. A team of 10 paediatric critical care nurses performs the assessment of the degree of discomfort once for each shift (morning, afternoon, and night) on two successive days using the Comfort Behavior Scale-Spanish version.
RESULTS: The Spanish version of the Comfort Behavior Scale obtained a scale level content validity index of 0.87. The Cronbach alpha coefficient was 0.715. The Spanish version of the Comfort Behavior Scale is a tool made up of three factors with two items in each domain: i) alertness and physical movement; ii) calmness-agitation and respiratory response/crying, and iii) muscle tone and facial tension. The 49.8% (n=155) of patients were free of discomfort vs. 50.2% (n=156) who suffered discomfort. There was observed to be a significant negative correlation between the length of stay in days (Rho= 0.16; p=0.02); that is, the longer the stay, the less the discomfort. On analysing the correlation between age and degree of discomfort it was found to be positive and significant (Rho=0.230; p<0.001); the greater the age, the greater the discomfort. Comparing all the children receiving sedoanalgesia (n=205) and having discomfort levels of 10.77±2.94 with those patients not receiving sedoanalgesia (n=106) and having discomfort levels of 11.96±2.80, we did find a statistically significant difference (X2=-
4.05; p<0.001).
CONCLUSIONS: The Spanish version of the Comfort Behavior Scale is able to determine and quantify the degree of discomfort of critically ill paediatric patients in the Spanish speaker context. Clinical care practice must include measurement of the degree of discomfort and the planning of activities designed to improve it, aimed at particular age groups and critically ill patients who are not receiving sedoanalgesia.
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Jam, Gatell M. Rosa. "Efecte de la càrrega de treball infermera en el compliment de les mesures preventives no farmacològiques de la pneumònia associada a ventilació mecànica." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/457192.
Full textAbstract:
La pneumònia associada a ventilació mecànica és l'esdeveniment advers evitable més prevalent i greu del pacient crític. Les infermeres tenen un paper essencial en l’aplicació de les mesures preventives no farmacològiques, ja que aquestes mesures estan directament relacionades amb els factors extrínsecs. Per tant, són potencialment modificables a través de la pràctica clínica infermera. L'adherència a les guies per evitar aquesta complicació és incompleta atribuint-se a factors com el dèficit de coneixement, la càrrega de treball, entre d'altres.
Es va proposar com objectiu d’aquesta tesi analitzar la càrrega de treball de la infermera com un factor que afecta l'aplicació de mesures no farmacològiques per la prevenció de la pneumònia associada a ventilació mecànica.
La metodologia de la investigació es va desenvolupar en dos fases. La primera d’elles va ser de pilotatge realitzada en una única unitat de cures intensives, que va permetre fer un anàlisi i una aproximació preliminar sobre la relació entre càrrega de treball de la infermera i adhesió a les mesures preventives no farmacològiques de la pneumònia associada a ventilació mecànica. La segona fase, més profunda i extensa, es va portar a terme en dues unitats de cures intensives, amb la intenció de validar els resultats obtinguts en la primera fase (unicentre). Per aquest motiu, a continuació es farà menció només a aquesta segona fase (multicentre). El disseny plantejat va ser d’un estudi observacional i transversal realitzat en dues unitats de cures intensives mèdic-quirúrgiques. La població estudiada van ser les infermeres de cures intensives que tinguessin al seu càrrec pacients sotmesos a qualsevol forma de ventilació mecànica i/o respiració espontània amb via aèria artificial (tub endotraqueal o traqueotomia). Les variables principals estudiades varen ser la càrrega de treball mesurada mitjançant el Nine Equivalents of Nurse Manpower Score, un qüestionari de coneixements i l’aplicació de les 9 mesures no farmacològiques seleccionades: manteniment del capçal del llit a 30º-45º, higiene bucal amb
clorhexidina (registre en gràfica), control de la pressió del pneumotaponament del tub endotraqueal (registre en gràfica), procediment d’aspiració de secrecions endotraqueals que incloïa la higiene de mans pre i post-aspiració, ús de sonda estèril i la seva manipulació de manera asèptica, ús de màscara i ulleres.
Els resultats mostren que la mitjana del Nine Equivalents of Nurse Manpower Score per infermera era de 50 ± 13. Les infermeres tenien un coneixement elevat de les mesures preventives a aplicar, amb una mitjana d’un 97.39%, però aquest no es corresponia amb la seva aplicació en la pràctica assistencial. Es va trobar una marcada variabilitat en l’adhesió a les mesures preventives no farmacològiques, anant entre l’11,9% per a la higiene de mans fins a gairebé el 100% per a l'ús d'una sonda d'aspiració estèril.
Es van realitzar un total de 327 observacions de 76 infermeres. L'anàlisi de regressió va detectar una associació significativa entre la càrrega de treball i l’aplicació de mesures preventives de la pneumònia associada a ventilació mecànica. En concret, a major càrrega de treball, major grau de compliment amb les mesures de prevenció no farmacològiques de la pneumònia associada a ventilació mecànica.
Quan es van analitzar factors relacionats amb les característiques de les infermeres observades, es va detectar una diferència significativa en el compliment amb les mesures de prevenció en els diferents grups d’edat, observant-se una major adherència en el grup de 31 a 40 anys i una menor adherència en els majors de 51 anys.
Amb aquest treball de tesi es pot concloure que una major càrrega de treball de la infermera, quantificada amb l’escala NEMS, no està associada amb un pitjor compliment de les MPNF. Alhora que el coneixement adequat que tenen les infermeres sobre les mesures de prevenció de la pneumònia associada a ventilació mecànica no s'aplica completament en la pràctica diària.
Els resultats suggereixen que la manca de compliment de les mesures de prevenció no es deriva de l'augment de la càrrega diària, sinó que podrien estar relacionat amb aspectes del comportament, estructurals i/o organitzatius.<br>Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious adverse events in critically ill patients. Since VAP can be prevented to some extent, clinical practice guidelines recommend several preventive measures, but the actual adherence with these measures is incomplete. The aim of the present thesis project was to analyze whether nursing workload is associated with the adherence to non-pharmacological prevention measures (NPPM) in the prevention of ventilator-associated pneumonia.
The project included two observational phases. The first pilot phase was conducted in a single medical-surgical ICU, and the second consisted in a multicenter observational study carried out in two medical-surgical ICUs. Nurses in charge of patients under ventilator support were observed during an endotracheal secretion aspiration procedure, and compliance with the application of non-pharmacological VAP prevention measures was determined. Nursing workload at the time of the observation was also computed, by means of the Nine Equivalents of Nursing Manpower Use Score (NEMS).
A total of 327 observations from 76 ICU-staff nurses were made and included in the analysis. Application of the specific preventive measures was uneven, ranging from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50 ± 13. Increased workload was not associated with the lack of application of preventive measures. In fact, compliance with NPPM was significantly lower in situations with lower workload. The application of the NPPM was also significantly different among nurses, independently of the workload.
The main conclusion of the present thesis project is that increased workload is not associated with the lack of adherence with NPPM for VAP prevention. Failure to follow these measures might be subject to other personal and/or contextual factors.
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Scorgie, Katrina Ann. "Novel adsorbents in intensive care medicine." Thesis, University of Brighton, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343608.
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Fisher, Joyce Ann. "Critical thinking in critical care nurses." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1036181.
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Critical care nurses need finely honed critical thinking skills in order to be safe, competent, and skillful practitioners of their profession. If clinical nurses do not learn how to reason effectively, they may make inappropriate decisions about their patients' care, ultimately resulting in increased patient mortality (Fonteyn, 1991). In addition, increasing nurses' decision-making and autonomy has been shown to improve job satisfaction and retention (Prescott, 1986).There are many authors who write about the need for developing critical thinking skills among practicing professional nurses (Creighton, 1984; Jenkins, 1985; Levenstein, 1981, 1983, 1984). However, research assessing the impact of continued education and clinical experience on the development of critical thinking skills is sparse.The purpose of this exploratory study is to determine if there is a relationship between the level of critical thinking skills (as measured by the Watson-Glaser Critical Thinking Appraisal Tool, 1980) in critical care nurses and the length of nursing experience, amount of continuing education pursued annually, and the level of formal nursing education completed. The conceptual framework that provides the basis for this study is Patricia Benner's (1984) application of the Dreyfus Model of Skill Acquisition to clinical nursing practice.Participants (N = 61) were obtained on a voluntary basis from the population of critical care nurses working in the intensive Care Unit, Coronary Care Unit, Cardiac Catheterization Laboratory, or Emergency Care Center of a 600 bed midwestern acute care facility. Each participant in the study was asked to sign an informed consent agreeing to participate after receiving a written and oral explanation of the study. Confidentiality of the participants was maintained by substituting identification numbers for the subjects' names on the data collection instruments. The investigator supervised the administration of the critical thinking instrument and demographic questionnaire.The Pearson product-moment correlation coefficient and a two-tailed t-test for independent samples were used to determine if there were any significant relationships between the WGCTA score and the length of critical care experience, attendance of continuing education programs, or completion of additional formal education. This data analysis supported hypothesis one with the results revealing a significant positive correlation (r = .46, p = <.001) between the WGCTA scores and the length of critical care experience. In addition, a statistically significant but weak positive correlation was found between the WGCTA scores and the length of experience in CCU (r = .52, p = .001). No significant correlation existed between the WGCTA scores and length of experience in ECC, ICU, or CCL. Hypothesis two was supported with a significant difference (t = 3.58, df = 59, p = .001) found between the critical thinking ability of the two groups, with those who have completed an additional formal program of nursing education scoring higher. A significant but weak positive correlation (r = .30, p =.020) was found between the number of continuing education programs attended annually and the WGCTA scores. Multiple regression was performed with the total WGCTA score being the dependent variable and total critical care experience, completion of additional formal education, and attendance of continuing education programs being the independent variables. Only total critical care experience entered the equation (E = 16.03, p = <.001) explaining 21% of the variance.The information gained from this study will provide direction for the review of existing orientation, continuing education, and staff development programs provided at different levels of nursing experience and make suggestions for change to enhance critical thinking skill development.<br>School of Nursing
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Roy, Amanda Jane. "Renal function in intensive care patients." Thesis, University of Liverpool, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.386868.
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Goldhill, David Raymond. "Identifying priorities in intensive care : a description of a system for collecting intensive care data, an analysis of the data collected, a critique of aspects of severity scoring systems used to compare intensive care outcome, identification of priorities in intensive care and proposals to improve outcome for intensive care patients." Thesis, Queen Mary, University of London, 1999. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1405.
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This thesis reviews the requirements for intensive care audit data and describes the development of ICARUS (Intensive Care Audit and Resource Utilisation System), a system to collect and analyse intensive care audit information. By the end of 1998 ICARUS contained information on over 45,000 intensive care admissions. A study was performed to determine the accuracy of the data collection and entry in ICARUS. The data in ICARUS was used to investigate some limitations of the APACHE II severity scoring system. The studies examined the effect of changes in physiological values and post-intensive care deaths, and the effect of casemix adjustment on mortality predicted by APACHE II. A hypothesis is presented that excess intensive care mortality in the United Kingdom may be concealed by intensive care mortality prediction models. A critical analysis of ICARUS data was undertaken to identify patient groups most likely to benefit from intensive care. This analysis revealed a high mortality in critically ill patients admitted from the wards to the intensive care unit. To help identify critically ill ward patients, the physiological values and procedures in the 24 hours before intensive care admission from the ward were recorded: examination of the results suggested that management of these patients could be improved. This led to the setting up of a patient at risk team (PART). Two studies report the effect of the PART on patients on the wards and on the patients admitted from the wards to the intensive care unit. Additional care for surgical patients on the wards is suggested as a way of improving the management of high-risk postoperative patients. The thesis concludes by discussing the benefits of the ICARUS system and speculating on the direction that should be taken for intensive care audit in the future.
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Corfee, Floraidh A. "Mental health and intensive care: A critical analysis." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/126393/1/Floraidh_Corfee_Thesis.pdf.
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This research addressed the social othering and positioning of mental health consumers in Australian society. Using a critical lens, the study explored the accounts of nurses caring for mental health consumers in intensive care. Interpretations of the accounts of interactions between nurses and consumers in this context brought focus to the ways in which nurses exercise legitimated power and privilege. It is hoped that the research will prompt critical reflection on the inherent structural power inequities in healthcare facilities and that political awareness of oppression and disenfranchisement of mental health consumers can be fostered among nurses as a professional group.
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de, Riva Solla Nicolás Gonzalo. "Advanced multimodal neuromonitoring: applicability for the pathophysiological study of intracranial pressure plateau waves." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/482188.
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INTRODUCTION Multimodal neuromonitoring increases the knowledge of the physiopathology underlying the pathological slow vasogenic waves known as ‘plateau waves’ of intracranial pressure (ICP).
The transcranial Doppler (TCD) pulsatility index (PI) describes changes in the morphology of the blood flow velocity (FV) waveform and is classically consider a descriptor of the distal cerebrovascular resistance (CVR).
Critical closing pressure (CCP) or zero-flow pressure denotes a threshold of arterial blood pressure (ABP) at which small cerebral vessels collapse and cerebral blood flow (CBF) ceases increasing the ischemic risk. The difference between CCP and ICP is explained by the tone of the small cerebral vessels, so-called wall tension (WT). Although it has inspired theoretical interest, its clinical applicability is limited for methodological reasons.
HYPOTHESIS 1) PI is a complex function determined by the interaction of multiple haemodynamic variables, and is not solely determined by distal CVR; 2) CCP and WT estimated with a cerebrovascular impedance model, could accurately define the pathophysiological changes during plateau waves.
AIMS 1) to clarify the relationship between PI and CVR; to define which factors truly influence PI; 2) to calculate CCP and arterial WT with a novel multiparametric mathematical model in order to examine the proposed vasodilatory pathophysiology of plateau waves; to evaluate its possible clinical appliance.
SUBJECTS AND METHODS Recordings from patients with severe head-injury undergoing monitoring of ABP, ICP, cerebral perfusion pressure (CPP), and TCD assessed CBF velocities (FV) were analysed. The Gosling PI was compared between baseline and ICP plateau waves (n
= 20 patients) or short-term (30–60 min) hypocapnia (n = 31). In addition, a modeling study was conducted with the ‘‘spectral’’ PI (calculated using fundamental harmonic of FV) resulting in a theoretical formula expressing the dependence of PI on balance of cerebrovascular impedances.
Multimodality neuromonitoring integrated with bio-informatics analysis (ICM+™ Software, www.neurosurg.cam.ac.uk/icmplus). Both studies are based in a multiparametric method new model of cerebrovascular impedance; first a retrospective study of 2 opposing physiological conditions comparing basal PI to: a) plateau waves (n= 20 patients, 38 plateau waves); and b) moderate hyperventilation (n=31); next CCP was calculated in the plateau waves group (n= 20). According to Burton’s model, wall tension was estimated as: WT = CCP-ICP.
RESULTS 1) PI increased significantly (p< 0.001) while CVR decreased (p< 0.001) during plateau waves. During hypocapnia both PI and CVR increased (p< 0.001). The modeling formula explained more than 65 % of the variability of Gosling PI and 90% of the variability of the ‘spectral’ PI (R=0.81 and R=0.95, respectively); 2) During the vasodilatory loop of the plateau waves, there is a rise in CCP and reduction in WT (both significant, p < 0.001). Change in CCP was correlated to ICP changes (R=0.80, p<0.001). Cerebral arterial WT decrement (a 34.3%) confirms its vasodilatatory origin. However, the effect of rising ICP is more pronounced than the corresponding vasodilatatory response decreasing WT. All results were significant with both traditional and multi-parameter methods of calculation.
The “safety collapsing margin” (ABP-CCP) decreased significantly (p < 0.001) from baseline ICP to plateau levels, indicating that the probability for brain vessels to collapse.
CONCLUSIONS 1) TCD- PI is usually misinterpreted as a descriptor of distal CVR. The presented mathematical model describes PI as a product of the interplay between CPP, the fundamental harmonic of ABP, CVR, compliance of the cerebral arterial bed and the heart rate;
2) During plateau waves, CCP increases significantly while active vasomotor tone, represented by WT, decreases due to vasodilation. A new mathematical model to estimate CCP based on the impedance methodology disallows non-physiologic negative values and provides a more physiological interpretation.<br>ANTECEDENTES: la neuromonitorización multimodal aumenta el conocimiento de la fisiopatología subyacente a las ondas plateau de hipertensión intracraneal. El índice de pulsatilidad (IP) del Doppler transcraneal (DTC) se considera un descriptor de las resistencias cerebrovasculares (RCV) distales. La presión crítica de cierre (critical closing pressure, CCP) es un umbral de presión arterial por debajo del cual los vasos cerebrales pequeños se colapsan interrumpiendo el flujo sanguíneo cerebral (FSC) y aumentando la lesión secundaria. Teóricamente útil, su aplicabilidad clínica está limitada por razones metodológicas.
HIPÓTESIS: 1) el IP está determinado por la interacción de múltiples variables hemodinámicas y no solo por las RCV; 2) la CCP (estimada mediante un modelo de impedancia cerebrovascular) aumenta durante las ondas plateau.
OBJETIVOS: 1) definir qué factores determinan el IP de la velocidad del FSC; 2) medir la CCP y verificar un nuevo método para su cálculo durante las ondas plateau.
METODOLOGÍA: pacientes con traumatismo craneoencefálico (TCE) monitorizados con presión arterial continua, presión intracraneal (PIC) y DTC. Análisis con un software específico (ICM+®) validado. Ambos trabajos se basan en un método multiparamétrico basado en un modelo de impedancia cerebrovascular: 1) estudio retrospectivo de 2 situaciones fisiológicas
contrapuestas comparando el IP basal con: a) ondas plateau (n= 20 pacientes, 38 ondas) y b) hiperventilación moderada (n=31); 2) cálculo de la CCP en el grupo de ondas plateau (n= 20). Según el modelo de Burton la tensión de la pared arterial (wall tension, WT) se estimó como: WT = CCP-PIC.
RESULTADOS: 1) durante las ondas plateau el IP aumenta de forma significativa pero las RCV disminuyen. Durante la hipocapnia aumentan el IP y las RCV; 2) La CCP aumenta significativamente en el plateau de la onda y la WT disminuye un 34.3%. El nuevo método matemático es más fisiológico.
CONCLUSIONES: 1) El IP no es solo un descriptor de la RCV distales, existiendo una compleja relación matemática con múltiples variables hemodinámicas; 2) La CCP aumenta durante las ondas plateau, pero la WT disminuye. Se aplica un nuevo modelo matemático para calcular la CCP que permite una interpretación más fisiológica de sus valores.
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Goldsborough, Jennifer. "Palliative Care Integration in the Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4787.
Full textAbstract:
Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.
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Hendricks, Lucia Elizabeth. "Critical thinking : perspectives and experiences of critical care nurses." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71821.
Full textAbstract:
Thesis (MCurr)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: The increasingly complex role of the critical care nurse in an intensive care environment demands a much higher level of critical thinking and clinical judgment skill than ever before. Critical thinking in nursing practice may be defined as the cognitive ability to analyse, predict and transform knowledge, ensuring quality nursing care. To reason from a nurse’s perspective requires that we learn the content of nursing; this includes the concepts, ideas and theories of nursing. The aim and objectives of the study were to explore critical care nurses’ perspectives and experiences with regards to the concept of critical thinking, facets influencing the application of critical thinking skills in clinical practice and how these impact on the delivery of quality nursing care.
A qualitative approach, using a case study design was utilised. A sample of six participants, who met the study inclusion criteria and consented to participate, were interviewed individually. Subsequently, five of these six participants took part in a focus group discussion to capture additional data to clarify and enrich the individual interview data. A field worker was present during the interviewing processes to note non-verbal data and later verify transcribed data. Feasibility of the proposed study was established by conducting a pretest which elicited relevant information. Ethical approval for the study was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Permission and consent was obtained from the relevant hospital group to interview nurses working in the intensive care units.
Qualitative content analysis, which focuses on the content or contextual meaning, was used to analyse interview data. Coding of the data through emergent themes and sub-themes was done by the researcher and supported through independent coding to verify and strengthen the analysis and interpretation of the researcher. .
The results depicted how the participants personally understood the concept of critical thinking and the components influencing the application of critical thinking skill in clinical practice. The study of the participants’ perspective of the concept of critical thinking and portrayed how they experience analytical and independent thinking, competence and confidence, as well as knowledge, skill and expertise, to influence the quality of patient care.
The data revealed several themes that facilitated critical thinking in critical care nurses. These themes were ‘team support’, ‘experience and exposure’ and ‘empowering the mind’. Emergent themes elaborating the limitations of critical thinking included ‘being stressed’, ‘professional boundaries’ and ‘being busy’.
Several recommendations and suggestions for future research were offered.<br>AFRIKAANSE OPSOMMING: Die toenemende komplekse rol van die kritieke-sorgverpleegster in ’n intensiewe-sorg omgewing verg ’n veel hoër vlak van kritiese denke en ’n kliniese oordeelvaardigheid as ooit tevore. Kritiese denke in ’n verplegingspraktyk kan gedefinieer word as die kognitiewe vermoë om te kan analiseer, om vooruit situasies te kan bepaal en die vermoë om kennis te omskep sodat kwaliteit verpleegsorg verseker kan word. Om soos ’n verpleegster te kan dink, stipuleer dat die inhoud van verpleging geleer moet word wat konsepte, idees en teorieë daarvan insluit.
Die doel en oogmerke van die studie is om die ervarings en perspektiewe van kritieke-sorgverpleegsters te ondersoek, met betrekking tot die konsep van kritiese denke, fasette wat die toepassing van kritiese denkvaardighede in ’n kliniese praktyk beïnvloed en die impak daarvan op die lewering van kwaliteit verpleegsorg.
Die metodologie wat toegepas is, is ’n kwalitatiewe benadering deur middel van ’n gevalle-studie ontwerp. ’n Steekproefgrootte van ses deelnemers wat aan die inklusiewe kriteria voldoen het, is mee onderhoude individueel gevoer en daarna is met vyf van hierdie ses deelnemers in ’n fokusgroep onderhoude gevoer ten einde data op te neem wat andersins verlore kon geraak het. ’n Veldwerker was teenwoordig gedurende die proses van onderhoudvoering om die opgeneemde en getranskribeerde data te verifieer. Die data-insamelingsinstrument is in die vorm van ’n onderhoudsgids ontwikkel om die navorser gedurende die onderhoudvoering te help. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die voorgestelde studie te ondersoek en is sodoende geskep om relevante inligting te onthul. Etiese goedkeuring vir die studie is verkry van die Gesondheidsnavorsing Etiese Komitee aan die Fakulteit van Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch. Goedkeuring en toestemming is van die hospitaalgroep aan wie die hospitaal behoort verkry, waar die studie onderneem is om sodoende onderhoude te kan voer met verpleegsters wat in die intensiewe-sorgeenhede werk.
’n Primêre, kwalitatiewe inhouds analise is gebruik om omderhoud data te analiseer wat fokus op die inhoud of kontekstuele betekenis daarvan. Kodering van die data deur die toepassing van die temas en sub-temas wat voorgekom het, is deur die navorser gedoen. Die data is onafhanklik gekodeer om die analise en interpretasie van die navorser te verifieer en te bekragtig ten einde die akkuraatheid en getrouheid in die formulering van die betekenis en interpretasie van gebeure met juiste weergawe daarvan, te verseker.
Die resultate wat as hooftemas vanuit die individuele onderhoude voortgespruit het, asook die van die fokusgroep het die deelnemers se eie begrip van die konsep van kritiese denke en komponente wat die toepassing van kritiese denkvaardigheid in ’n kliniese praktyk beïnvloed, getoon. Die konsep van kritiese denke het die wyse waarop analitiese en onafhankilke denke, bevoegdheid en selfvertroue, asook kennis, vaardigheid en kundigheid die kwaliteit van pasiëntsorg beïnvloed, uitgebeeld.
Die voortkomende data het daartoe aanleiding gegee dat die faktore wat die fasilitering en beperking van kritiese denke beïnvloed, bespreek kon word. Data rakende fasilitering het getoon hoedat die ondersteuning van die span, ervaring, blootstelling en die verruiming van die gees, kritieke-sorgverpleegsters positief kan beïnvloed om kritiese denke in hulle daaglikse verplegingsaktiwiteite effektief te kan toepas. Data wat verband hou met beperkings het getoon hoedat stres, professionele kwessies en besigwees kritieke-sorgverpleegsters negatief kan beïnvloed in die toepassing van kritiese denke gedurende daaglikse verplegingsaktiwiteite. Verskeie aanbevelings vir toekomstige navorsing is voorgestel.
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Ferrel, Cynthia Lynn. "The experience of critical care nurses in initiating hospice care." abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.
Full textAbstract:
Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.<br>School of Nursing
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Leccisi, Michael S. G. "Decision making in an intensive care environment in medicine." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=24089.
Full textAbstract:
Medical professions associated with time pressured environments, incorporate apprenticeship as part of training. While our understanding of decision making has moved towards examining these environments, how does this knowledge apply to instruction in these contexts?<br>Specific reasoning strategies identified by Patel are useful in assessing medical instruction. Rasmussen's guidelines and Patel's protocol analytic methods are applied in this thesis to assess two time-pressured environments of a local hospital. In the medical and surgical intensive care unit, resident physician instruction and patient care co-occur withing the context of problem solving and decision making.<br>Differences between the two environments include a flattened hierarchy of communication, information exchange, and decision making content. Trainees approximated the proportion of directed reasoning strategies used by supervisors. Results are attributed to differences in knowledge-based solution strategy use, and medical domain structure. Implications for design of more guided apprenticeship programs is discussed.
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Thomson, Anne H. "The measurement of lung mechanics during neonatal intensive care." Thesis, University of Aberdeen, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.377624.
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The aim of this thesis was to establish methods of measuring the mechanical properties of the respiratory system in small infants while they were being ventilated in the intensive care unit. A double pneumotachograph system which fitted in the ventilator bias flow-circuit was used to measure flow, overcoming the problems of adding resistance or dead space to the infant's breathing circuit. Two methods for measuring compliance in infants (< 1500 g) breathing spontaneously through endotracheal tubes were assessed. The traditional measurement of dynamic lung compliance (Cdyn) using oesophageal pressue was compared with a technique for measuring total respiratory compliance (Crs) based on the utilisation of the Hering-Breuer reflex (Olinsky 1976) and using airway pressure. Values of Cdyn were poorly reproducible and correlated poorly with Crs and this was due to variability and inaccuracy of oesophageal pressure measurement in infants with chest wall distortion. Total respiratory compliance was reliably measured in intubated infants both when breathing spontaneously and when fully ventilated. Another approach based on the passive expiratory flow-volume relationship (Zin 1982) was developed for use in ventilated infants. The expiratory time constant (Trs) was measured and total respiratory resistance (Rrs) calculated from the relationship Trs = Rrs.Crs. This technique was validated by adding resistive loads and deriving new volumes for Rrs from the altered Trs. The first measurements of the time constant and respiratory resistance of preterm infants during the acute stage of illness were made using this technique. Representative mean values from 12 infants < 1500 g with hyaline membrane disease were Crs = 0.41 ml.cmH<sub>2</sub>O<sup>-1</sup>; Trs = 0.073 s; Rrs = 219 cmH<sub>2</sub>O.ℓ-1.s. A computerised technique was developed to enable these measurements to be made at the cotside. This provided a preliminary model for a lung function monitor to assess mechanical lung function continuously during neonatal ventilation.
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Crawford, Theresa E. "Factors influencing critical care nurses' involvement with families in the intensive care unit." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0034/MQ66627.pdf.
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Mendizabal-Espinosa, R. M. "A critical realist study of neonatal intensive care in Mexico." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1546182/.
Full textAbstract:
Neonatal intensive care units (NICU) aim not only to reduce mortality and morbidity but also to promote babies' future well-being and health. Baby-led (evidence-based) practices take into account babies' physical and emotional needs. They also consider parents' needs and, when possible, encourage parental participation. Based on ethnographic field work over the course of ten months, the study examined interactions among healthcare professionals, parents and babies in two Mexican NICUs. Dialectic critical realism underpinned the analysis of data while ideas taken from the new sociology of childhood contributed to an investigation about babies as service users of healthcare facilities in their own right. This thesis contributes to an understanding of why preterm babies in Mexico are cared for as they are and opens ways forward towards changes in practice. Three overarching themes, moral and physical hygiene, dignity and well-being, illuminated discussion of results. I identify theory/practice inconsistencies that arise when discourses about sanitation, breastfeeding and babies' best interests are used to control and oppress service users of public hospitals (babies and their parents) rather than to protect them. I have found evidence that relationships between healthcare staff and service users were influenced by prejudices about social class, gender and ethnicity, which resulted in deficient care and disrespect of basic human rights. I consider how wider structures such as neoliberal policies, Catholic practices, poverty, corruption and violence influenced the day-to-day life in these hospitals. The thesis concludes by identifying three ways in which practice might be improved: a) to consider nurses as agents of transformational change; b) to create multi-disciplinary teamwork, including parents and babies, in order to enhance communication at all levels; and c) to develop routine procedures and practices in the NICU informed by research evidence of high standards of care. Finally, I identify implications and steps for further research.
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Mkoko, Philasande. "HIV positive patients in intensive care - a retrospective chart review." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20959.
Full textAbstract:
Background: The indications for and outcomes of intensive care unit (ICU) admission of HIV - infected patients in resource - poor settings like Sub - Saharan Africa are unknown. Methods: We reviewed case records of HIV - infected patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, South Africa from 1 January 2012 to 31 December 2012. HIV infection was defined as two positive antibody tests. Results: Seventy seven HIV - infected patients were admitted to ICU, 2 were younger than 18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during this period. HIV - positive patients had a mean (± standard deviation) CD 4 count of 293.9 × 10 6 /L ± 247.2 × 10 6 /L. Respiratory illness accounted for 30.7% of ICU admissions, community - acquired pneumonia was responsible for the majority of the respiratory cases. ICU and hospital mortality was 25.3% and 34.7% respectively. Predictors of ICU mortality included an APACHE Ι Ι score >13 (Odds Ratio {OR } , 1.4; 95% confidence interval {CI } 1.1 - 1.7; p value 0.015), receipt of renal replacement therapy (OR, 2.2; 95% CI 1.2 - 4.1; P 0.018) and receipt of inotropes (OR 2.3; 95% CI 1.6 - 3.4; P <0.001). Predictors of hospital mortality were severe sepsis on admission (OR, 2.8; 95% CI 0.9 - 9.1;p 0.07), receipt of renal replacement therapy (OR, 1.9; 95% CI 1.0 - 3.6; p 0.056), receipt of inotropic support (OR, 2.0; 95% CI 1.4 - 3.2; p 0.001). Use of highly active antiretroviral therapy, CD4 count, detectable HIV viral load and the diagnoses at ICU admission did not predict ICU or hospital mortality. Conclusion Respiratory illnesses remain the main indication for ICU in HIV infected patients. HIV is diagnosed late with patients presenting in dire straits. Receipt of HAART, CD4 count and the diagnoses at ICU admission are not predictors of ICU or hospital mortality, but rather the severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and renal replacement.